Report #2902973

Received Jul 9, 2026

Died

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 75 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 22, 2026
Onset: Jul 9, 2026
Days to onset: 78
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052786	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

BIPOLAR DISORDER, UNSPECIFIED, UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE, NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY, FISTULA OF BILE DUCT, CHRONIC CHOLECYSTITIS, CHRONIC PULMONARY EMBOLISM, ANTISOCIAL PERSONALITY DISORDER, LUPUS ANTICOAGULANT SYNDROME,

Other medications

Aspirin, Metoprolol, Furosemide, Warfarin, Oxymetazoline nasal spray, Ipratropium-Albuterol solution, Spironolactone, Jardiance, Pantoprazole sodium, Clonazepam, Guaifenesin, Quetiapine, Xylimelts, Triamcinolone cream, Silver nitrate applic

Allergies

no known allergies